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Comment & Response
December 2018

Minding Our Metaphors

Author Affiliations
  • 1Internal Medicine–Pediatrics Residency Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Pediatr. 2018;172(12):1199. doi:10.1001/jamapediatrics.2018.4155

To the Editor We suspect that as a neuropsychiatry and behavioral health trainee, Loper would never think to use a term such as retarded or imbecilic to describe someone or something. And yet he—and the reviewers and editors at JAMA Pediatrics—have used “acquired physician autism” to describe an unfortunate feature of the practice of medicine today.1 It is an analogous slur to the R word. We should heed the example of history—from immigrants being described as plagues to German Jews being called a cancer—not to use illness terms or metaphors to describe what is wrong with a group of people. Not only does this practice pathologize the second group, but it reinforces the negative connotations associated with the first group. Persons on the autism spectrum are neurologically different, not broken. Furthermore, they have no choice in the matter, unlike us practicing physicians who are so often the face of modern medicine (when not hidden behind a computer screen!). While we sympathize with Loper’s difficulties in balancing his compassion for his patients with the administrative expectations with which he is yoked, we do not believe that the issue is any more illuminated by making an analogy to a neurodevelopmental condition than headlines that mistakenly use schizophrenic to mean of 2 minds. As physicians who serve neurologically diverse children and adults, we applaud The Mighty’s reporting of JAMA Pediatrics’ retroactive realization that this provocative term should never have been printed.2

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